Provider Demographics
NPI:1083153506
Name:RIVERA, LUZ ELENA (LCSW)
Entity Type:Individual
Prefix:
First Name:LUZ ELENA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 PROGRESSIVE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2849
Mailing Address - Country:US
Mailing Address - Phone:757-524-1995
Mailing Address - Fax:888-816-7113
Practice Address - Street 1:1210 PROGRESSIVE DR STE 102
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2849
Practice Address - Country:US
Practice Address - Phone:757-524-1995
Practice Address - Fax:888-816-7113
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040098031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical